四维超声时空关联成像纳入常规胎儿心脏筛查的可行性

摘要

目的 探讨四维超声时空关联成像技术纳入常规胎儿心脏筛查的可行性.方法 应用STIC技术获取的数据库中随机选择30例心脏结构畸形和30例心脏结构正常的胎儿作为研究对象.60例胎儿心脏经产后随访或尸解有54例获得明确诊断结果.后由4组(A、B、C、D组)不同水平的医师在不知道诊断结果的情况下对先前存盘的心脏容积数据做快速离线分析.从事产科超声检查5年及以上者定为具有产前二维超声筛查经验的高水平医师,和5年以下者定为中低水平医师；应用STIC技术1年及以上即定为STIC技术应用经验丰富.A组具有中低水平的产前二维超声筛查经验无STIC技术应用经验,B组具有中低水平产前二维超声筛查经验但有STIC技术应用经验,C组具有高水平产前二维超声筛查经验而无STIC技术应用经验,D组既有高水平产前二维超声筛查经验又有丰富的STIC技术应用经验.结果 A、B、C、D4组正确诊断率分别为:75.00％、77.78％、84.26％、87.04％;A组与B组、C组与D组、A组与C组、B组与D组比较正确诊断率均无明显差别(x2值分别为0.23、0.34、2.85、3.19,P均＞0.05);A组与D组比较有差别(x2 =5.09,P＜0.05).总正确诊断率为81.02％ (350/432).结论 STIC技术易于掌握且对医师的专业经验依赖性小,可以纳入常规胎儿先天性心脏病的筛查中.%Objective To investigate the feasibility of four-dimensional ultrasound imaging using spatiotemporal image correlation(STIC) in routine fetal heart screening. Methods From the volumes gained previously by STIC technology we selected 30 fetuses with heart malformations and 30 fetuses with normal heart randomly as our research object. The results of prenatal diagnosis were followed up, either by postnatal echocardiography or by necropsy. Four group sonographers( A,B,C,D) participating in the offline analysis didn't know any diagnosis result. Every group consists of two sonographers. The sonographer engaged in obstetrics sonographic over five years is thought to have high level two-dimensional(2D) echocardiographic experience or to be low-to-medium level. And the one used STIC technology for one year is thought to be skillful. Physicians in Group A and B have low-to-medium level 2D echocardiographic experience. Physicians in A group have experience using STIC technology but physicians in B group haven't. Physicians in C and D group have high level 2D echocardiographic experience. Physicians in C group have no experience of STIC technology but physicians in D group have. Results The accuracy rating of diagnosis of four groups are 75. 00% ,77. 78% ,84. 26% and 87. 04% respectively. There was no obvious difference between Group A and Group B,Group C and Group D,Group A and Group C,Group B and Group D(x2 is 0. 23,0. 34,2. 85,3. 19 respectively, P> 0. 05) .but there was difference between Group A and Group D(x2 =5. 09,P<0. 05). The overall accuracy rating of diagnosis is 81. 02%(350/432). Conclusions This study has shown that STIC technology is easy to grasp rarely dependent on sonographers work experience; therefore, incorporation of STIC volume acquisition into the routine fetal heart screening program is feasible.